Friday, November 30, 2012

Should epileptics be allowed to drive?

By Meluse Kapatamoyo

Should epileptics be allowed to drive? That was the question onlookers at the scene of a recent accident in Lusaka asked as they stood by and watched a motorist who had had a seizure behind the wheel ram into another car.

The more conscientious among the bystanders helped him out of the car he was driving and laid him on the floor next to a hardware shop as he twitched and foamed at the mouth.

Thankfully, no –one was injured in the accident and the driver of the care he had hit into made a compassionate decision not to press charges.

But his decision did not absolve the epileptic motorist from blame for driving when the unpredictability of his condition posed a risk to him and a greater risk to motorists and pedestrians alike.

But Epilepsy Association of Zambia president Anthony Zimba has a different point of view about whether or not those who suffer seizures should be licensed to drive.

EAZ President Anthony Zimba
He says frequency of the seizures, epileptic or non- epileptic, what time they come and whether the patient is on medication or not, determines whether the patient should get behind the wheel. 

“If someone has active seizures, meaning they are frequent and come during the day and that person is on medication, such people are not supposed to drive. But if the seizures only come at night, we may have a discretion and allow that person to drive,” he explained.

People, whose seizures are irregular and only come once a year or once every six months, can also be given a go-ahead by medical practitioners to get on the road. But, they can only drive light vehicles and not passenger vehicles such as mini-buses or trucks.

People with irregular seizures and not on medication, should not drive.

RTSA has recorded 600 deaths in the third quarter of 2012
However, while these precautions can mean life or death, for the driver and other road users, these are not laws. Health practitioners can only advice. The final decision is with the patient who has the right to decide whether to drive or not. Unfortunately, many get on the road.

Mr Zimba said, “If there were regulations, which we do not have in this country, in a situation as the one at Millennium Bus stop, if it’s confirmed epilepsy, that persons licence can be suspended until such a time when the seizures have stopped completely and they have been on treatment for two and half years. Only then can their licence be lifted. With any laws, all we can do is for now is plead with our patients not to drive, some do, but because the majority of people hide their condition even from employers, they end up driving.”

Zambia is one of the many countries in Africa that have no regulations for persons with epilepsy or seizures. But, countries like South Africa have formulated some guidelines.

According to the South African National Road Traffic Act, you are not permitted to drive if you have uncontrolled epilepsy. Nonetheless, they too have left the final decision of whether to drive or not to the individual concerned and their health doctor.

In addition, Epilepsy South Africa, has formulated the following guidelines for people with epilepsy; if you change or stop your medication suddenly, stop driving until your doctor advises it’s safe to do so. If you have a seizure for the first time in years, stop driving and consult your doctor. Don’t drive when you’re tired, stressed or ill, as you’re more likely to have a seizure at such time. Never drink and drive.

Unfortunately, ‘epilepsy can happen anywhere and at anytime,’ early this year, a man was killed when he crashed into a primary school in SAs Cape Town, apparently while suffering an epileptic seizure. Two children were also injured.

The incident drew a lot of national interest, with condolence messages going to the deceased family and speedy recovery messages to the two kids who were injured. Concerns were also raised as to whether the man should have been driving given his condition.

In the United Kingdom, the Driver and Vehicle Licensing Agency (DVLA) is the condition that licenses cars and drivers for driving on public roads. Its guidelines say if you have a driving licence, by law it is your duty to tell the DVLA about any medical condition which may affect your ability to drive, including epilepsy. This is a condition of holding a driving licence.

According to the Epilepsy Society, “if you have a driving licence, and have a seizure of any kind, the DVLA regulations say that you must stop driving. You are responsible for telling the DVLA and returning your licence to them.

“The regulations cover all epileptic seizures: auras and warning, seizures where you are conscious, myoclonic jerks, and seizures where you lose consciousness.”

In Zambia, every expectant driver must conduct a medical test for audio and visual capacities, where obvious disabilities are also noted, Road Traffic and Safety Agency (RTSA) Principal Publicity Officer says, “Problems such as epileptics cannot be diagnosed, unless the person reveals on their own that they suffer from this condition. And then evidently RTSA would not give a license because such a disease is not planned for any attack.”

Conducting drivers test involves a theoretical test that requires knowledge o the Highway Code involves a practical test that requires ones skills such as reversing, turning right, left and simply propelling the vehicles. Road skills such as getting into the reality of driving where there is traffic are also conducted with a RTSA examiner.

“I am not sure what type of machines can determine someone's driving skills except to have tests that take the drivers on the road and they are practically tested by examiners. RTSA has never recorded or received any reports of seizures as causes of accidents on the road,” said Khozi.

The agency recorded 8, 801 accidents, in the third quarter of 2012, that  led to 600 deaths.PYM 

Tuesday, November 20, 2012

As long as homosexuality is criminal, ‘zero new infections’ of HIV will not be achievable

By Dr Mannasseh Phiri

Dr Mannasseh Phiri

At the beginning of last week, the world received the news that our neighbours in Malawi had suspended laws against same-sex relationships pending a parliamentary decision on whether to repeal the laws or not. Police have been ordered not to arrest anyone involved in homosexual relationships or acts, until the laws have been reviewed. The Malawian government hopes that the suspension of the laws will spark off national debate which will help parliament guide the country as appropriate.

Back in May 2012, newly installed President Joyce Banda had said in her maiden ‘state of the nation’ address to parliament that laws regarding indecent practices and unnatural acts would be repealed. In suspending the laws, President Banda has taken a very bold step in a country that, like Zambia and most countries in Africa, has strong conservative views opposed to homosexuality.

In Zambia, the government has not given us any leadership or guidance save for a non-committal and glum statement by the then Information Minister and Government Spokesman Fackson Shamenda during the fierce public debate that followed UN Secretary General Ban Ki Moon’s visit to Zambia in February 2012. Mr Shamenda was reported to have said Zambia has laws on homosexuality, and will follow those laws. By implication this meant that Zambia’s official stand was not to follow Ban Ki Moon’s advice that Zambia should respect the rights of gay people.

Another raging public debate took place in the lead up to the Presidential elections in 2011. The ruling MMD came across and published some ‘evidence’ that PF President Michael Sata had told foreign journalists that when his party came into power they would review the laws on homosexuality. A ridiculous political circus followed, fuelled by the state print media. Michael Sata was demonised as a gay-loving presidential candidate who would legalise same-sex marriages if voted into power. The debate was so heated, filled with hate and laughable homophobic rhetoric and Zambians saw through it and voted for Sata as President. Unfortunately, neither Sata nor anyone in his government has said anything about the need to review the laws against homosexuality.

In Reflecting on AIDS on June 3rd, inspired by President Joyce Banda’s announcement to parliament, I lamented: “With our neighbours to the east and to the south having spoken out at the highest political level (about homosexuality), albeit in diametrically opposed directions, where is Zambia’s leadership on the spectrum between Malawi’s
legalization and Zimbabwe’s homophobic rhetoric? Don’t you so wish we could at least hear from President Michael Sata or Dr Guy Scott where they want to take Zambia on this subject? I do.”

There still has been no comment or reaction from the venerated gentlemen and their colleagues. (In fact there has hardly been any official comment on any major HIV issues – especially from the top most political echelons. Since he came into office, the President has hardly said anything at all - ad lib or otherwise - about HIV and AIDS in Zambia (let alone MSM and gay rights. He has also not acknowledged or denied that he said in an interview that he would review laws criminalising same-sex relationships. –– in one year plus. The interview (if indeed it did take place) has not been published in Zambia. National collective head-in-the-sand homophobia continues as we watch and marvel as the courageous lady leader next door suspends the law so that it can be re-visited, and reviewed sans pressure.

Official government documents on the shape and character of Zambia’s HIV epidemic identify one of the Key Drivers of HIV infections in Zambia as ‘vulnerable and marginalised populations (including MSM and prisoners). Despite it being criminal, men are having sex with other men in Zambia in prisons and outside. We also know there is a ‘significant’ gay community in Zambian cities and towns. Their activities have a bearing on the general epidemic and if they are not investigated and new infections continue to arise unabated and uncontrolled among them, we shall never get to ‘zero new infections’.

We also know that recently government approved studies on HIV and AIDS in our prisons that prisoners (men especially) are acquiring HIV in prisons in significant numbers. In 7 provincial prisons surveyed, the HIV prevalence is double what it is outside prison. Where is the legality, logic and culpability if our systems are condemning people to prisons where we know some of them will be infected with HIV? Where, as certainly as the Zambezi River flows into the Indian Ocean, some of them will be released, come out and infect their partners with the virus?

Where is the legality, logic and culpability if our prison systems do not provide condoms freely and openly inside the prisons so prisoners can protect themselves against infection? Where is our collective national conscience when we have been provided the facts and continue to look away?

I once had then Information Minister Given Lubinda as my guest on TalkingAIDS on JOY FM. I asked him the straight blunt question: “On whose hands is the blood of people who are sentenced to prison and die of AIDS after being infected with HIV inside the prison?” His answer was equally straight and blunt: “The Government”! And I thought, “Touche!”

If we are serious about Zambia achieving “zero new HIV infections”, we must find and expose all the nooks and crannies where new infections take place. Is the illegality of homosexuality making people afraid to seek HIV testing care and support?

We must, like Malawi, boldly suspend the laws against same-sex relationships for research be done, and for our legal minds and parliament to review the laws and inform us if these laws are even legal. We must do this however unpleasant, unpalatable, unacceptable, un-Christian, ‘un-Zambian’ or ‘un-African’ we think the practice is.

Like Malawi, this needs bold political leadership. I challenge President Michael Sata to lead us forward in this specific issue because I know he can.

Wednesday, November 7, 2012

Pregnant? 4 could save your life


In most African societies, pregnancies are rarely planned, and as a result it takes women a few months before they can make that all important first trip to a health institution for Ante-natal care (ANC).

However, while the woman waits to come to terms with being pregnant, she may be putting her life and that of her unborn child at risk.

Effective ANC which includes a minimum of four visits to a health care centre, has been cited as an effective way of reducing mortality in mothers and children.
A pregnant woman attending ante-natal/ Photo by UNICEF

Dr Mulindi Mwanahamuntu, a gynaecology consultant at the University Teaching Hospital (UTH) said the four visit minimum requirement as recommended by the World Health Organisation (WHO) is enough for a clinician to identify at least 80 percent of problems that occur in a pregnancy.

“This recommendation is a compromise from having a woman coming every other week to burden the health-system. Sometimes the clinician will ask the woman to be coming to the clinic every other week depending on the problem she may have. But a minimum of four visits has been shown and proven to reduce maternal and child deaths,” he said.

“Opportunities for Africa’s Newborns”, a report by the World Health Organisation (WHO) states that to achieve the full life-saving potential that ANC promises for women and babies, four visits providing essential evidence-based interventions should be adhered to.

The essential elements of ANC include identification and management of obstetric complications such as pre-eclampsia, tetanus toxoid immunisation, intermittent, preventive treatment for malaria during pregnancy (IPTp), and identification and management of infections including HIV, syphilis and other sexually transmitted infections (STIs).

“ANC is also an opportunity to promote healthy behaviours such as breast feeding, early postnatal care, and planning for optimal pregnancy spacing,” says the report.

Zambia is among countries in Southern Africa battling maternal and child mortality, caused by lack of commitment by pregnant women to attend ante-natal where diseases such as malaria, sexually transmitted infections (STIs) and HIV can be screened early.

WHO estimates that 900,000 babies die as stillbirths during the last twelve weeks of pregnancy. And babies, who die before the onset of labour, or antepartum (bleeding) stillbirths, account for two-thirds of all stillbirths in countries where the mortality rate is greater than 22, per 1,000 births-accounting for nearly all African countries.

Four ante-natal visits could save the life of your unborn child
In addition, maternal mortality remains equally high in many countries too. In Zambia, the UN organisation estimates 830 maternal deaths per 100, 000 live births accounting for one in every 120 pregnant women.

And according to Dr Mwanahamuntu, in Zambia, despite 94 percent of women especially those in urban areas attending ante-natal, less than 75 percent of them deliver in some form of health institution.

“In this case, the whole purpose of the earlier ante-natal visits is defeated. For rural areas where visits drop to almost zero, simple conditions that can be picked up by clinicians are missed. If we are to win this battle and succeed, we must emphasise on institutional delivery of babies. Child birth is a physiological undertaking and women should not die from something that should be normal.” said Dr Mwanahamuntu. PYM